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August 30, 2006

Diagnosis and Symptoms

Question from Huntsville, Alabama, USA:

I had written to you about a week ago about my daughter. She had a few high readings which prompted her pediatrician to send her to an endocrinologist. Her glucose tolerance test was normal, but we have been continuing to monitor her blood sugar. Her fasting readings have all been above 110 mg/dl [6.1 mmol/L] with only one reading exceeding 126 mg/dl [7.0 mmol/L]. The other morning, after breakfast, I checked her and she was 322 mg/dl [17.9 mmol/L]. Twenty minutes later, she was 210 mg/dl [11.7 mmol/L]. Another 20 minutes later, her blood sugar was 195 mg/dl [10.8 mmol/L]. I called her endocrinologist who said that it was likely that my daughter is in the early stages of type 1 diabetes. But, all of her laboratory work had come back normal. The only thing they mentioned to me was that the week prior, the pediatrician had done an A1c and it was 4.9 and when they did it a week later it was 5.4. Do you think there is any significance to that? I realize these are very normal A1c values, but do they normally jump in a week's time? Also, is it at all possible that the doctors are wrong about this being early stages of type 1? Can a non-diabetic have a reading of 322 mg/dl [17.9 mmol/L] and fasting readings over 110 mg/dl [6.1 mmol/L] every day?

Answer:

Sorry, but I would agree with your endocrinologist that this is most likely the early stages of type 1 diabetes. A1c levels are an average of several weeks of glucose levels, so, if her values are periodically higher, then the A1c could slowly and steadily climb like this. One cannot make a diagnosis of diabetes with A1c levels, but the blood sugar levels you report are definitely not normal, as you suspect. I would agree with continued monitoring, watching her weight and reporting back to the endocrinologist if there are sustained higher blood sugar levels, weight loss, change in urination/thirst, etc.

SB